Download The Valsalva maneuver is performed by attempting to forcibly exhale

Valsalva Maneuver
Definition
The Valsalva maneuver is performed by attempting to forcibly exhale while keeping the mouth and nose c
losed. It is used as a diagnostic tool to evaluatethe condition of the heart and is sometimes done as a trea
tment to correct abnormal heart rhythms or relieve chest pain.
Purpose
The Valsalva maneuver is used with patients who have suspected heart abnormalities, often in conjunctio
n with echocardiography. The maneuver isbased on the fact that when a patient forcibly exhales against
a closed nose and mouth while bearing down, as if having a bowel movement, specificchanges occur in
blood pressure and the rate and volume of blood returning to the heart.
Comparing the changes in a diseased heart to those expected in a normal heart gives clues to the type a
nd location of heart damage. In addition, when adoctor listens to the chest with a stethoscope during the
Valsalva maneuver, characteristic heart sounds are heard. Variations in these sounds can indicatethe typ
e of abnormality present in the heart. A 2004 study found that blood pressure response to the Valsalva m
aneuver could predict mortality in elderlypatients with congestive heart
failure. This could prove to be a new noninvasive way to help determine how long elderly patients with co
ngestive heartfailure are expected to live.
The Valsalva maneuver also corrects some rapid heartbeats originating in the atria. When the maneuver i
s done correctly, blood pressure rises. Thisforces the heart to respond by correcting its rhythm and beatin
g more slowly. On rare occasions, the Valsalva maneuver can be used to diminish chestpain in patients w
ith mild coronary disease.
Unrelated to any evaluation of the heart, the Valsalva maneuver also is taught to patients with multiple
sclerosis who are unable to fully empty thebladder (flaccid bladder). It sometimes is used in sexual thera
py to help men avoid premature ejaculation.
Precautions
The Valsalva maneuver should not be performed by patients who have severe coronary artery
disease, have experienced recent heart attack, or have amoderate to severe reduction in blood volume.
Description
When performed formally, the patient is asked to blow against an aneroid pressure measuring device (ma
nometer) and maintain a pressure of 40millimeters of mercury (mm Hg) for 30 seconds. Or, less formally,
the patient may be asked to bear down, as if having a bowel movement. During this 30second period, a r
ecording is made of the changes in blood pressure and murmurs of the heart.
Preparation
The patient may be connected to a heart monitor and echocardiograph or the physician may simply use a
stethoscope to monitor the heart. Sometimes anindwelling needle is inserted for accurate pressure meas
urements, depending on whether the procedure is being done for corrective or diagnosticpurposes.
Aftercare
When this procedure is done to regulate irregular heart rhythms, the patient usually remains on a heart m
onitor to evaluate heartbeat.
Risks
The patient may feel dizzy or faint during the procedure, but serious consequences are rare. There is a ris
k that the Valsalva maneuver can cause blood
clots to detach, bleeding, and abnormal rhythms originating in the ventricle. It can also cause cardiac arr
est. Consequently, the procedure is usuallyperformed in a setting where emergency equipment is accessi
ble.
Normal results
There are four characteristic changes or phases in a normal heart's response to the Valsalva maneuver.
An abnormality in any of these phases indicates acardiovascular abnormality.